REV-17-2924 Miami Shores Village RECEIVED
Building Department DEC 122017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
N LINE PHONE NUMBER:(305)762 4949 g
REVIm"' 11
FBC 201 !
BUILDING
VNeRSu
Permit No. DDS-10-17-288��3//��
PERMIT APPLI - Permit No. f� � — G'"12A
❑BUILDING ❑ ELECTRIC ❑ ROOFING 0 REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 93 N.W. 97th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3101-033-0250 Is the Building Historically Designated:Yes NO,
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): BARBARA DELGADO Phone#:305-815-1922
Address: 93 N.W. 97th Street
City: MIAMI SHORES State: FLORIDA Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: wt- 1r Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$0.00 Square/Linear Footage of Work: 92
Type of Work: ❑ ,Addition ElAlteration 1:1New Q Repair/Replace ❑ Demolition
Description of work: CONCRETE STEPS
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Specify color of color thru tile:
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Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ ,-21 Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ 20 Bond$
5 �
TOTAL FEE NOW DUE$ I .
(Revised 02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address _
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address t n
City States '+ Zip-
Application is hereby made to obtain a permit to do'the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature_ �l i Signat re W
OWNER or AGENT CONTRACTOR
The foregoing instrument was a knowledged before me this The foregoing instr ent was acknowledged before me this
�-day of \ 20 1 by day of 20 by
�,XICC C�C1�C� who i personall know to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
1\
Sign: Sign:
Print: , VALERIE S AVS 14b Print:
10, Wary Public-SVeo
Seal: Commission# 014084 Seal:
My Comm.Es Nov 18,2020
B=WthtwoNaWwlNotary Assn.
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APPROVED BY 1 Plans Examiner Zoning
4
' t Structural Review _ Clerk
(Revised 02/24/2014)
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---------. DEC 12 ��
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Miami Shores Village
APPROVED BY DAT
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ZONING DEPT
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TO COMPLIE,NCE WI FH ` �_I�� _ ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
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